- Global Channel Management Inc. (East Hartford, CT)
- About the job Medicaid Appeals Coordinator Medicaid Appeals Coordinator needs 2+ years of grievance or appeals experience Medicaid Appeals ... degree (minimum of Associates) or equivalent work experience 2+ years of grievance or appeals experience Ability to effectively relate to a wide range of… more
- Macpower Digital Assets Edge (Los Angeles, CA)
- Job Summary: The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for the overall training strategy across the ... department. This position designs and conducts training programs using established regulatory and departmental guidelines. This position is responsible for providing ongoing training on the core processing system, A&G processing procedures, training regulatory… more
- The City University of New York (New York, NY)
- …assessment, BIT/student support case management, freedom of expression oversight, and grievance and appeals resolution. Collaborate with various departments and ... student conduct reports; coordinating the student conduct process, grievances, and appeals . Oversee the Faculty Student Disciplinary Committee to ensure compliance… more
- Inland Empire Health Plan (Rancho Cucamonga, CA)
- …not limited to, case management, quality management, utilization management (UM), and grievance and appeals and committee participation. The Medical Director of ... Behavioral Health oversees the inpatient/concurrent review process, care integration efforts, and all levels of behavioral health care provided to IEHP Members. The Medical Director coordinates care with the County Mental Health Plans that are responsible for… more
- CAPPS (Austin, TX)
- …youth grievances, as needed; and develops and assists with developing responses to grievance appeals and alleged mistreatments related to dietary and nutrition ... staff to develop and maintain effective processes for staff. Monitors youth grievance trends relating to the nutrition and food services program; investigates… more
- Covenant College Students (Lookout Mountain, GA)
- …summarized in the Staff Manual policy on Fair Treatment as well as the Grievance and Appeals Procedure . (Integrity, Faithfulness) Attend chapel services at ... least once per week, on average. (Integrity, Faithfulness) Competencies Must be a Covenant student. Work Environment This job operates in a professional office environment. This role routinely uses standard office equipment such as computers and phones.… more
- Covenant College Students (Lookout Mountain, GA)
- …summarized in the Staff Manual policy on Fair Treatment as well as the Grievance and Appeals Procedure. (Integrity, Faithfulness) Attend chapel services at least ... once per week, on average. (Integrity, Faithfulness) Work Environment This job operates in a classroom and lab studio environment. Physical Demands Sitting: Remaining in the seated position Lifting: Raising or lowering an object from one level to another… more
- Randstad (Worcester, MA)
- …regulatory requirements and individual expectations. This role serves to administer the appeals and grievance process as outlined in handbooks, departmental ... standards. This role is responsible for triaging and assigning all incoming appeals and grievances and will also provide administrative support to the department.… more
- PHI Health (Phoenix, AZ)
- …timely payments. This includes escalation of issue to supervisors and/or grievance departments. Categorize and quantify payer payment issues for resolution and ... policies and procedures. Draft correspondence to patients and payers including 1st level appeals for technical denials, and identify accounts to refer to Appeals … more
- Elevance Health (Durham, NC)
- **Manager II Grievance / Appeals ** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... an accommodation is granted as required by law._ The **Manager II Grievance / Appeals ** responsible for management oversight of grievances and appeals … more
- Elevance Health (Cerritos, CA)
- **Title: Grievance / Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... employment, unless an accommodation is granted as required by law._ " The ** Grievance / Appeals Analyst I** is an entry level position in the Enterprise … more
- Elevance Health (Columbus, GA)
- ** Grievance / Appeals Analyst Senior** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... onboarding and skill development. Shift hours: 8:00am - 4:30pm EST** The ** Grievance / Appeals Analyst Senior** is responsible for reviewing, analyzing, and… more
- Robert Half Accountemps (Los Angeles, CA)
- Description A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist. The Grievance & Appeals Specialist, will be ... denied claims, complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform research and utilize your… more
- Centene Corporation (Phoenix, AZ)
- …member and provider complaints, grievances and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims or related managed care experience. Strong oral, written,… more
- Centene Corporation (Phoenix, AZ)
- …member and provider complaints, grievances and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims or related managed care experience. Strong oral, written,… more
- Commonwealth Care Alliance (Boston, MA)
- …**Supervision Exercised:** No **Essential Duties & Responsibilities** Processing of Grievances & Appeals : + Responsible for the progress of grievance and appeal ... pharmacy, dental, reporting, and member services. + Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day tasks and assignments.… more
- Molina Healthcare (San Antonio, TX)
- …**Job Summary** Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and ... dispute/ appeals processing. * Establishes member and non-contracted provider grievance /dispute and appeals policies/procedures and updates annually or as… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services ... Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC...Coordinates, tracks, and resolves internal and external appeal and grievance complaints for LA Care Plan Partners, including identifying… more
- Molina Healthcare (St. Petersburg, FL)
- …Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving ... in line with state and federal regulations. Responsible for managing the Appeals and Grievance department inventories within the key performance requirements.… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... and evaluation by the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB to identify areas of improvement to assist the… more
